ELCS or VBAC?

[FaceTheRaven80]

Another one of these threads I know, sorry!

I had a traumatic first labour - I was in active labour for 4 days, we both got an infection in labour and had to have a crash section due to his heart rate plummeting and my own blood pressure was going insane. All was well in the end but it was a shit birth.

I wanted a ELCS this time but I'm being talked about of it and starting to have second thoughts myself. I'm 21 weeks.

My BMI is 40, which both means VBAC is less likely to succeed and a C section is riskier. I would avoid the health risks of an unsuccessful VBAC but there are risks with ELCS as well (to me, and to the baby - it is associated apparently with an increased incidence of developing autism though I have no idea why? Maybe it's a causation/correlation thing?).

I am under consultant care and they keep telling me my risk of losing a lot of blood is high. They are optimistic about a VBAC as I got to 9cm dilation - I am not optimistic due to many factors but a big one being worsening SPD which is beginning to affect my mobility.

My recovery from my EMCS last time was fine though I didn't manage to establish breastfeeding but there was multiple factors for that. I do have some bladder weirdness as well.

Due to mental health issues, I have to begin prophylactic antipsychotics before birth which, this time, will pretty much rule out breastfeeding anyway. It also means that even with a totally uncomplicated VBAC I will still not be allowed to leave hospital - like last time I will be kept in 3-4 days for monitoring for mental health (which is crap, and was horrible last time).

The pro of the ELCS is removing some of the uncertainty and anxiety. I don't want to go into labour and end up with an EMCS anyway. I don't really have a burning desire to give birth vaginally - I did feel like I'd "failed" last time but have long since moved past those feelings - the blunt truth is we both would have died otherwise.

It would also be obviously better for arranging childcare.

The cons are I'm scared of the recovery being complicated, the doctor has scared me about blood loss and not being able to drive for months.

The pros of a VBAC are only there for me if it is straightforward. I am pretty terrified of forceps and being cut!

This will be my last child.

What would you do in my situation?

Bump

There's so much here that's out of your control, I would choose an ELCS to remove the element of uncertainty about how a VBAC might go.

ELCS!
I’ve had a natural birth go badly and have to live with birth injuries. Second child was elective c section and I wouldn’t hesitate to have another c section.
I hope you can make your peace with this decision and it all goes well. Best of luck !

Definitely the ELCS! I had an emergency c-section first time round and had no interest in a Vbac second time. Consultants were keen for me to try Vbac and I had to push back very hard to get the ELCS I wanted.

I have to say, if you have no burning desire to try for a VBAC and this is your last baby, I’d definitely go for an ELCS in your situation.

I would have thought that of all the variants (ELCS, EMCS, VBAC), an ELCS was the safest option for reducing risks around blood loss - the staff can be prepared, there’s no rush, you’re already in theatre if there’s a problem.

I had to make this decision last year, albeit with different history and risk factors. I had to listen to some absolute bollocks about the benefits of VBAC and risks of ELCS (to clarify, the risks part was absolutely valid but the risks of VBAC were completely ignored, as were the benefits of ELCS). In the end, I booked a section for 41 weeks if I didn’t labour - and I didn’t so had the section.

If you want the section, stand firm. If you want to try for a VBAC, but with a very low threshold for moving to a section, that’s also something you could discuss.

Your first labour sounds a lot like my first. Now 28+5 with 2nd and pretty much decided I'm going for a ELCS. Feelings about 1st birth sound very similar to mine as well and this is also likely to be my last child. No other health problems but I just feel like there are fewer unknowns with an ELCS, and I don't want to go through another long labour just to end up with a section again anyway. I think if I was adding other health considerations in like you are it would cement the decision, especially if you've got the support afterwards and don't need to worry too much about being out of action for a couple of weeks - it doesn't sound like there's any reason for your doctor to be so pesssimistic about the length of your recovery, especially if you recovered ok from an EMCS with all the attendant exhaustion and stress.

If you felt differently about a wanting a natural birth I'd encourage you to try a VBAC and be prepared to flip to section if things aren't going well/if you go overdue.

But as you really don't sound desperate to birth vaginally, and have a whole host of other things to think about around your birth plan re your physical and mental health, I'd opt for ELCS. I know the risks of blood loss, recovery etc sound scary; but you'll be in a hospital surrounded by staff who are aware of those risks - it seems like as you'd be in there anyway recovery time will be less of an issue as you'll be helped with baby by the staff.

The one thing I'd say is make sure you have a really strong-minded birth partner who will advocate for you. Everyone is busy and staff may need pressing to take your concerns seriously and monitor you closely.

I speak as someone who had an EMCS and the physical recovery from that was actually pretty easy - very painful for about 48 hours and then got to grips pretty quickly. Don't be fobbed off with bloody paracetamol, especially if you're not planning to breastfeed - demand the good stuff! No other major surgery patients are expected to grin and bear it on 2 paracetamol.

I'm 17 weeks now and had a similar birth to you (failed induction, went on for bloody days, cervix stuck at 6cm, EMCS) so am facing the same dilemma. The difference is I really really want to experience a natural birth, and to avoid a long stay (or ideally any stay) in hospital because it was bloody torture on the antenatal ward last time.

In your case a hospital stay is pretty well assured, and you have gotten past your disappointment in your previous birth not going to plan, so why put yourself through the stress and the worry and the (reasonably high) chance a VBAC won't work out?

Good luck with your birth and enjoy your baby x

Thank you everyone 😊 This has helped cement some of my thinking around this and I will be asking for an ELCS. My husband agrees with me and thankfully he will be able to take on the bulk of the initial care this time too.